Physicians, firearms and frustration over gun violence

The tragic mass murder of children and adults in Newtown, Conn. has elevated the divisive issue of preventing injuries and deaths from firearms to the top of the national policy debate. It has also renewed a potentially divisive debate within the medical profession on what role physicians and their professional organizations should play.

The case for physician engagement is strong. The medical profession hasn’t shied away from other controversial issues that can harm their patients, whether it involves taking on the tobacco industry or advocating for universal access to health insurance. How could the profession then not speak out on firearms-related murders and suicides that result in more than 30,000 preventable deaths per year?

“Why does gun violence deserve physicians’ time and energy?” writes Christine Laine, MD, MPH, FACP, editor of Annals of Internal Medicine and the lead author of an editorial published Jan. 1 in the journal.

“Guns maim and kill,” the editorial notes. “Even when we can repair torn tissue and prevent death, bullets permanently diminish the quality of life of persons caught in the line of fire. Gun violence also harms those close to the victims who often endure grief, depression, anxiety, and sometimes posttraumatic stress disorder. Furthermore, whether they experience single shootings or massacres, persons in affected communities and the widening circles around them suffer when gun violence makes them feel unsafe in their schools, streets, stores, workplaces, and recreational venues.”

The American College of Physicians, in a Dec. 20 statement on the Newtown shooting, restated its long-standing support for “banning the sale of assault-type weapons and high capacity (ammunition) magazines that are designed to kill as many people as possible in the shortest possible time.”

The College also called for strengthening access to mental health services and pledged to “review the research on the most effective approaches to reduce firearms-related injuries and deaths, and then from this review, offer our ideas for a multi-faceted, comprehensive approach.”

On Jan. 16, the College expressed support for many of President Obama’s proposals to reduce firearms-related injuries and deaths, including requiring universal background checks, lifting prohibitions on federally funded research on deaths and injuries from firearms, clarifying that federal law does not prohibit physicians from counseling patients about firearms in the home, improving access to mental health services, and banning assault-style weapons and high-capacity magazines.

Engaging in this issue is not without its risks, including the fact that physicians are not of one mind on policies to limit sales or ownership of firearms and ammunition or require universal background checks.

Some physicians echo the “Guns don’t kill; people kill” argument of the National Rifle Association and the argument that a culture of violence and lack of access to mental health services, not legally owned firearms, are at fault. They point to the 2008 Supreme Court ruling of District of Columbia vs. Heller that individual ownership of firearms is protected by the Second Amendment.

Other physicians believe with equal fervor that only by restricting access to firearms can the United States greatly reduce deaths and injuries related to them, even if some of those restrictions would be rejected by a broad swath of the public who legally own firearms and pose no threat to others, including some of their firearms-owning physician colleagues.

How can medicine reduce the divisions within its own ranks? A crucial first step is for each side to respectfully consider each other’s perspectives. Physicians who support reasonable restrictions on firearms should listen to the perspectives of their colleagues, many of whom live in nonurban areas with relatively low crime rates. Many of them own legal firearms or know people who do and are concerned about restrictions on what the Constitution guarantees as a constitutional right.

Physicians who own firearms and oppose restrictions on firearms should listen to the perspectives of their colleagues who support control over firearms, many of whom live in urban areas where violence from firearms is a paramount concern. Most physician-advocates for reasonable restrictions on firearms, such as requiring universal background checks and prohibiting sale of assault-style weapons, are not trying to take legally purchased guns away from responsible owners, only trying to keep them out of the hands of people who would use them for harm and to reduce deaths and injuries when they are used.

Equally important, physicians on all sides must be willing to follow the evidence, even if it leads to conclusions that challenge their preconceived notions.

Following the evidence shouldn’t be an excuse to avoid taking a position or acting now, however. As Dr. Laine and her coauthors so eloquently stated, it is essential that physicians and their professional societies speak out about firearms-related violence. The risk of dividing the profession is a real one, but an energetic debate among colleagues can be a good thing, as long as all sides respectfully listen to each other and are willing to consider the evidence, wherever it leads them.

This is the process that ACP has followed in developing the policies that allow us to engage in the issue today, and it is the process it will follow as the College takes a broader look at all facets of the problem over the next several months.

The greatest risk of all is that every minute physicians don’t speak out, more children and adults will be at risk from a person using firearms to harm them, in their classrooms, in their own homes, in their workplaces and on their neighborhood streets.

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